Earlier onset of type 1 diabetes associated with increased risk for adverse outcomes
medwireNews: Patients with type 1 diabetes diagnosed before the age of 10 years have a higher risk for cardiovascular complications and a shorter life expectancy than those who develop the disease at an older age, study results published in The Lancet suggest.
“These findings advance the arguments for wider and earlier use of cardioprotective agents in this population,” say Araz Rawshani (University of Gothenburg, Sweden) and fellow researchers.
In an analysis of data from 27,195 individuals with type 1 diabetes and 135,178 controls matched for age, sex, and county, Rawshani and colleagues found that patients aged 0–10 years at the time of diabetes onset were 11.5 times more likely to develop cardiovascular disease (CVD) over a median follow-up of 10 years than control individuals after adjustment for factors including diabetes duration and comorbidities.
By comparison, patients who were diagnosed with diabetes at the age of 11–15, 16–20, and 21–25 years had an 8.0-, 6.0-, and 4.3-fold elevated CVD risk, respectively, while those in the oldest age group for diabetes diagnosis (26–30 years) had the smallest increased risk relative to controls, at 3.9-fold.
The researchers found a similar pattern of results for coronary heart disease, acute myocardial infarction, stroke, and heart failure risk, with patients in the youngest age group for diabetes onset having the greatest risk increase relative to control individuals, and those in the oldest age group having the smallest increase in risk. The magnitude of risk increase was greatest for myocardial infarction, with patients who developed diabetes at 0–10 years having a 31-fold increased risk compared with controls.
Furthermore, there were “notable differences” in the risk for CVD, coronary heart disease, and myocardial infarction between men and women, say Rawshani and team, highlighting that “women had greater excess risk throughout all age groups studied.”
The researchers also report “marked differences” in life expectancy among patients diagnosed with diabetes at different ages. For example, males who were diagnosed before the age of 10 years were estimated to lose 14.2 life–years and females diagnosed at the same age were estimated to lose 17.7 life-years. Among those diagnosed between the age of 26 and 30, however, these estimates decreased to a corresponding 9.4 and 10.1 life–years lost.
“These data are sobering, have implications for therapy, and are a further impetus to delay, prevent, and cure type 1 diabetes,” say Marina Basina and David Maahs, both from Stanford University in California, USA, in an accompanying commentary.
The researchers say that there are a number of options to reduce the risk for CVD in type 1 diabetes patients, including statins, antihypertensive medication, insulin pumps, and continuous glucose measurement. They stress, however, that “[w]e are not advocating giving statins or ACE inhibitors to children with type 1 diabetes,” but rather advocating “greater consideration of statins once individuals with early-onset type 1 diabetes reach 30–40 years of age.”
And the commentators conclude: “Practitioners need a stronger evidence base, including confirmatory reports from other registries and clinical trials, to clarify proper therapy and translate research findings to care guidelines and clinical practice to improve mortality and cardiovascular disease outcomes for individuals with type 1 diabetes.”
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